Ultrasound Guided IV insertions

wyosamRN · Oct 19, 2016

At what point are you having trouble? Puncturing the vein, advancing the cath, locating a suitable location?

offlabel · Oct 19, 2016

You took the course and have been successful... don't sweat it. You've gone past the 'honeymoon' phase and now it's real. Dry patches are common. Watch other people doing it or YouTube a couple.

Also, for a while you should be more conservative in your vessel selection. Don't even try the smaller ones for a while.

Lastly be sure to use a lot of local... like 2-3 cc of at least .5% lido. Makes it painless and that means less stress for you.

brewski09 · Oct 20, 2016

I echo the question of what part are you having difficulty with because there are bound to be plenty of certified people on here that might be able to help with more info.

I've yet to use any lido or other pain mitigating mess for U/S PIV insertion (it isn't in our standard practice for adult patients) and many of our patients thank us for getting an IV so they don't have to get poked again.

pluckyduck, MSN, NP · Oct 20, 2016

I would say occasionally puncturing the vein but mostly advancing the catheter once I get flashback. I think I'm hitting the wall of the vessel--just on top, or the side. I try to pull back and change my angle and readvance but no luck. And I'm not allowed to use lidocaine unfortunately, it's not in our standard practice at my workplace. :/

Kuriin, BSN, RN · Oct 20, 2016

My HCAHP paper was based on USGPIV and pain reduction and no where in all of my research did hospitals mention they use lidocaine before.

MikeyT-c-IV · Oct 20, 2016

I've been using ultrasound almost exclusively for PIV's for about 8 years (they call me for the difficult starts). My advice is to just keep practicing. It takes a while to get really good.

My biggest pointer is to practice at knowing exactly where the tip of your needle is. Learn to point and move the probe along with the needle tip as you advance to and in the vessel. I sometimes can see my needle tip hit the back side of the vein so I can see I need to back up just a hair so that the catheter will advance.

Good job, BTW, for taking the initiative and learning the skill. It's tough at first but your patients will love you for it.

offlabel · Oct 22, 2016

My HCAHP paper was based on USGPIV and pain reduction and no where in all of my research did hospitals mention they use lidocaine before.

I don't know what HCAHP or USGPIV are, but I know that using lidocaine for any IV in an awake patient is humane, very safe and a good idea. RN's use it on our labor and delivery units, and all of our pre-procedural areas.

It makes a big difference in our patient satisfaction scores that the hospital pays attention to.

Bobjohnny · Oct 29, 2016

I don't know what HCAHP or USGPIV are, but I know that using lidocaine for any IV in an awake patient is humane, very safe and a good idea.

Ultrasound Guided Peripheral IV? No idea what an HCAHP is.

Y'all really use lido for every IV insertion? That seems excessive, at least to me, but to each their own. My thought process for this has always been, "Why get stuck twice when you can get stuck once?" But, its not within our standard protocols & we'd have to obtain an order every time we do it.

Anecdotally, it seems as if the few times I've interacted with people that use lido consistently have lower success rates. But, this is also just when pre-op can't get an IV and calls the ED (the lido is in their protocols).

offlabel · Oct 29, 2016

Ultrasound Guided Peripheral IV? No idea what an HCAHP is.
Y'all really use lido for every IV insertion? That seems excessive, at least to me, but to each their own. My thought process for this has always been, "Why get stuck twice when you can get stuck once?" But, its not within our standard protocols & we'd have to obtain an order every time we do it.
Anecdotally, it seems as if the few times I've interacted with people that use lido consistently have lower success rates. But, this is also just when pre-op can't get an IV and calls the ED (the lido is in their protocols).

A slow injection with a 27 ga needle for a lidocaine wheal is pretty painless compared to an IV catheter, especially big ones. When you use buffered lidocaine, there is hardly any sensation at all. When I can, I place 16 or larger pretty routinely and I wouldn't put patients through that without a good reason.

Many years ago I wouldn't use any anesthetic because no one else did and pain with getting an IV was just taken for granted. Now I wouldn't think of not using lido in an awake patient. They're stressed out enough as it is.

AZQuik · Nov 1, 2016

Are you using a cross sectional view or longitudinal view?

**NickiLaughs, ADN, BSN, RN** · Nov 3, 2016

I don't know what HCAHP or USGPIV are, but I know that using lidocaine for any IV in an awake patient is humane, very safe and a good idea. RN's use it on our labor and delivery units, and all of our pre-procedural areas.
It makes a big difference in our patient satisfaction scores that the hospital pays attention to.

I'm guessing you guys have this as a protocol? Lidocaine is viewed as a med and without either an order or as part of a protocol we can't go grab lido for everyone's IV. In the ER that's not really always an option (traumas, emergent cases, etc) very few of our IVs are "routine." I'd be interested in knowing how often this is being used in hospitals. We do use EMLA for peds though if they're stable enough.